From the Guidelines
The most diagnostic approach for a hard lump with serous discharge and an ultrasound showing a retroareolar mass with irregular borders is Excision biopsy (C). This approach is recommended because it provides a definitive tissue diagnosis, which is essential for determining the nature of the mass and guiding further management decisions 1. While fine needle aspiration biopsy (FNB) is a minimally invasive procedure that can provide cellular material for cytological examination, it has limitations, including the need for pathologists with specific expertise in interpreting test results and the potential need for follow-up tissue biopsy if atypia or malignancy is identified 1. In contrast, excisional biopsy involves removal of the entire breast mass or suspicious area, providing a more comprehensive tissue sample for histopathological examination. Key advantages of excisional biopsy include:
- Higher diagnostic accuracy compared to FNB, particularly for nonpalpable breast lesions 1
- Ability to obtain tissue samples of sufficient size to eliminate the need for follow-up biopsy to confirm malignancy
- Provision of a definitive diagnosis, which is essential for determining the optimal treatment plan. Given the clinical presentation of a hard lump with serous discharge and an ultrasound showing a retroareolar mass with irregular borders, excisional biopsy is the most appropriate diagnostic approach to ensure accurate diagnosis and guide further management decisions.
From the Research
Diagnostic Approach
The case presented involves a hard lump with serous discharge, and ultrasound shows a mass retroareolar with an irregular border. To determine the most diagnostic approach, we can consider the following options:
- Fine-needle aspiration biopsy (FNAB)
- Excision biopsy
Comparison of Diagnostic Methods
Studies have compared the efficacy of different diagnostic methods for breast lesions:
- A study published in 2009 2 found that the ideal method for diagnosis of breast cancer is debatable, and the choice of method depends on various factors, including the size of the tumor and where the patient first presents.
- Another study published in 2020 3 found that core needle biopsy (CNB) is a reliable method for diagnosing benign breast papillomas, but larger lesion size and smaller biopsy needle size were associated with an increased risk of upgrade to atypia or cancer.
- A study published in 2007 4 highlighted the importance of needle core biopsy (NCB) in providing accurate histological diagnosis and prognostic information for breast cancer.
Recommendation
Based on the available evidence, excision biopsy (option C) is likely the most diagnostic approach for this case, as it provides a definitive diagnosis and allows for further evaluation of the lesion. While FNAB (option A) can be a useful diagnostic tool, it may not provide sufficient information for a definitive diagnosis, especially in cases with complex or atypical lesions.
Key Considerations
When choosing a diagnostic approach, consider the following factors:
- The size and location of the lesion
- The presence of suspicious ultrasound features
- The patient's clinical presentation and medical history
- The potential risks and benefits of each diagnostic method